White Rose Manor

Type of visit: Case Management - Annual Continuation

On 3/24/26 LPA returned to this facility at approximately 9:30am to complete annual inspection. Previously, on 3/20/25 Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by designee. Facility currently has five (5) residents in care one (1)vof which are currently on hospice. Upon arrival, LPA observed caregiver (S1) present and working in facility but not listed on Guardian roster printed 3/19/26. During LPA inspection of physical plant S1 left the facility. Designee provided LPA with S1's personal information including birthday, driver's license, and last name, but this person turned out not to be the person that was actually present. Person actually present was staff (S2). S2 name and birthday given to LPA. Per designee, S2 does not have fingerprint clearance but has been working for about 2 weeks at facility. LPA advised S2 cannot return to facility until S2 has fingerprint clearance (deficiency cited, see 809D and civil penalty assessed in the amount of $100 per day for 5 days for a total of $500, see LIC421BG). Licensee is aware that S2 did not have fingerprint clearance as she is the one responsible for hiring staff and associating staff to facility, not designee. At approximately 2:40pm LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Box containing 150 eggs left outside of refrigeration inside garage, temperature today was 96 degrees F outside (deficiency cited, see 809D) LPA observed refrigerator in garage to be storing food but was not cool, no thermostat so no temperature reading available but refrigerator was also leaking water out form the bottom. Garage has two [2] refrigerators and one freezer. Per designee, the other refrigerator has also been leaking and licensee is aware (deficiency cited, see 809D). Light is broken on Continued on 809C... Continued from 809... refrigerator in kitchen. Tile around kitchen sink is in disrepair and showing areas of black and gray substance. Additionally, on 3/24/26 at approximately 2pm LPA spoke with visiting repair individual (I1) from HCB construction. I1 reported to LPA that sink has been leaking for quite some time. I1 reported to LPA that they observed under kitchen sink mold all over: plywood that has mold and has rotted, sides of the cabinet have mold, garbage disposal is covered with rust, and water lines are also covered with rust (deficiency cited, see 809D). Cleaning products and laundry soaps are inaccessible to residents in care. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required grab bars but private bath in room #1 did not have mat. Water temperature in sinks measured at 109.2 degrees F in the kitchen and 109.3 degrees F in the bathroom used by residents, both of which are within the allowable range of 105 to 120 degrees F. Facility has another bathroom used by staff only. Fire extinguishers were last inspected 1/14/25, but showing as fully charged. Smoke/Carbon Monoxide detectors tested and operational. During inspection of physical plant LPA observed medication cabinet to be open and unlocked (deficiency cited, see 809D). Additionally, LPA observed medications and supplements in staff room, however, room was locked. LPA advised it could be a good practice to keep all prescription medications if not locked, then secured in a drawer or something in the event that the staff room is accidentally left unlocked. Fireplace in dining area needs a screen. LPA spoke to resident (R1) who informed LPA that staff make all the residents go to their rooms between the hours of 1pm and 3pm. R1 informed LPA that they wanted to go outside but was told they had to stay in their room. LPA immediately informed staff that residents have personal rights, one of which is to have to make choices concerning their daily life in the facility (deficiency cited, see 809D). LPA observed residents lying in bed staring at the wall or ceiling. LPA advised designee residents need to have activities to participate in and have cognitive stimulation that meets their needs. LPA did not observe residents engaged in any activities for the duration of both LPA's visits (deficiency cited, see 809D). Additionally, R2's hospice care plan dated 3/6/26 on page 6 of 9 social worker indicates adding a TV to their room for additional diversion. Continued on 809C(2)... Continued form 809C... Per designee, they were not aware of the social worker's suggestion. While LPA present, caregivers added a television to R2's room and adjusted their bed so as to have a good view. On 3/24/26, LPA began resident file review at approximately 9:45am. LPA reviewed five [5] out of five [5] resident files. LPA observed full rails on bed for residents (R1 and R2). R2 is on hospice but R1 is not (deficiency cited, see 809D). Per designee they will remove full rails rather than request an exception. LPA began staff file review at approximately 11:00am. S3, S4, and S5 do not have restricted conditions training on file and S6 does not have any training at all on file (deficiency cited, see 809D). S3 and S4 need 8 hours of in-service medication training completed each year (deficiency cited, see 809D). S5 and S6 need a total of 10 hours of initial medication training (deficiency cited, see 809D). S5 did have some medication testing documented but no hours of duration noted on documentation. Training completed by a vendor. Vendor not on the approved vendor list. LPA will forward to licensee approved vendor list. Additionally, S6 did not have a health screen or TB clearance on file (deficiency cited, see 809D). At approximately 1:45pm LPA and designee did a spot check of medication and medication records. Medication is centrally stored in cabinet. Facility has mini-refrigerator for medication needing refrigeration. R1 had prescription for Doxycycline Monohydrate 100mg, that was not listed on the Centrally Stored Medication Log (CSML) and R3 did not have a CSML (deficiency cited, see 809D). Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with House Manager and a copy of this report was given.the state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by designee. Facility currently has five (5) residents in care one (1)vof which are currently on hospice. Upon arrival, LPA observed caregiver (S1) present and working in facility but not listed on Guardian roster printed 3/19/26. During LPA inspection of physical plant S1 left the facility. Designee provided LPA with S1's personal information including birthday, driver's license, and last name, but this person turned out not to be the person that was actually presen. Person actually present was staff (S2). S2 name and birthday given to LPA. Per designee, S2 does not have fingerprint clearance. LPA advised S2 cannot return to facility until S2 has fingerprint clearance (deficiency cited, see 809D). Licensee is aware that S2 did not have fingerprint clearance as she is the one responsible for hiring staff and associating staff to facility. At approximately 2:40pm LPA toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Box containing 150 eggs left outside of refrigeration inside garage, temperature today was 96 degrees F outside (deficiency cited, see 809D) LPA observed refrigerator to not be cool, no temperature reading available but refrigerator was leaking. Garage has two [2] refrigerators and one freezer. Per designee, the other refrigerator has also been leaking and licensee is aware. Light is broken on refrigerator in kitchen. Tile around kitchen sink is in disrepair and showing areas of black and gray substance (deficiency cited, see 809D). Cleaning products and laundry soaps are inaccessible to residents in care. All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required grab bars but private bath in room #1 did not have mat. Water temperature in sinks measured at 109.2 degrees F in Continued on 809C... Continued from 809... the kitchen and 109.3 degrees F in the bathroom used by residents, both of which are within the allowable range of 105 to 120 degrees F. Facility has another bathroom used by staff only. Fire extinguishers were last inspected 1/14/25, but showing as fully charged. Smoke/Carbon Monoxide detectors tested and operational. During inspection of physical plant LPA observed medication cabinet to be open and unlocked (deficiency cited, see 809D). Additionally, LPA observed medications and supplements in staff room, however, room was locked. LPA advised it could be a good practice to keep all prescription medications if not locked, then secured in a drawer or something in the event that the staff room is accidentally left unlocked. Fireplace in dining area needs a screen. LPA spoke to resident (R1) who informed LPA that staff make all the residents go to their rooms between the hours of 1pm and 3pm. R1 informed LPA that they wanted to go outside but was told they had to stay in their room. LPA immediately informed staff that residents have personal rights, one of which is to have to make choices concerning their daily life in the facility (deficiency cited, see 809D). LPA observed residents lying in bed staring at the wall or ceiling. LPA advised designee residents need to have activities to participate in and have cognitive stimulation that meets their needs (deficiency cited, see 809D). LPA will return at a later date to conduct file review, complete inspection, and issue citations on 809Ds for those items noted today as deficiency cited. Exit interview conducted with designee and a copy of this report given.the state’s words, verbatim · CDSS document, Mar 20, 2026

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual visit of the facility. LPA was welcomed by staff Glenda Castle. Georgiana R Santos Licensee/Administrator was contacted by facility staff on the telephone and wasn’t able to be present for this visit, LPA spoke with Licensee authorizing staff to sign documents. RCFE is a single story 6 bedroom, 3 bathroom with fire clearance for six Non-Ambulatory of which 3 may be bedridden in rooms 2, 3, & 4 and Hospice Waiver for 3. There is currently a total of 6 residents, 4 with diagnosis of dementia, one resident on hospice. Facility tour/inspection began at 1:10 PM: LPA toured the facility with staff Glenda; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices that were working properly during time of visit. Fire Extinguisher was found to be last charged on 1/24/2025 at the time of the visit. Smoke/carbon monoxide detectors are hard wired throughout facility, last inspected by Fire Dept. 2/25/2025. Hot water temperature measured 105 degrees F and 107.2 degrees F in 2 out of 2 resident bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Sharps/knives are stored in locked container on kitchen counter, toxins are stored in the garage in a locked laundry cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower, although at this time there is a shower wheelchair most residents are currently sitting in while being bathed in the shower. All bedrooms have lighting & appropriate furnishings. Continue on LIC809-C Continued from LIC809 File Review began at 2:00 PM: A review of five resident & four staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files and learned 5 out of 5 resident resident records reviewed have updated re-appraisals/needs & care plans and 5 out of 5 residents have current physician’s reports. All files are current. LPA reviewed a sample of staff records and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff annual training requirements for 2024 are on file. LPA was presented with proof of CPR & 1st Aid certification for staff that files were reviewed. Medications were centrally stored in locked cabinet in the facility office room area. Facility has a 30-day supply of medication for residents. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. Administrator Certificate for Administrator, Georgiano Santos 7005931740 expires 8/25/2026. Last Disaster Drill was conducted on 2/6/2025. Disaster drills are to be conducted quarterly and in different shifts. No Citations given at today's inspection Exit interview conducted with Designee. LPA Hansen is requesting facility to submit the following documents to CCL by 3/25/2025: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Current Administrators Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Mar 11, 2025

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual visit of the facility. LPA was welcomed by staff Glenda Castle. Georgiana R Santos Licensee/Administrator was contacted by facility staff on the telephone and wasn’t able to be present for this visit, LPA spoke with Licensee authorizing staff to sign documents. There is a total of six residents, 4 with diagnosis of dementia, 1 resident on hospice. Facility tour/inspection began at 8:45AM: LPA toured the facility with staff Evangeline; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Exits were equipped with auditory devices that were working properly during the visit. The one Fire Extinguisher was found to be last charged on 1/24/2022 at the time of the visit out of Title 22 regulations (see LIC809-D). Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured 107.7 degrees F and 108.6 degrees F in 2 out of 2 resident bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit; although cleaning supplies were stored under kitchen sink with food (see pic & LIC809-D) and were removed by staff. At approximately 9:00am LPA observed in kitchen with staff, broken lock on knife/sharps drawer which is a danger to residents in care (see pic & LIC809-D). Toxins are stored in the garage in a locked laundry cabinet; although on 1/3/2023 at 9:20am LPA observed cleaning supplies w bleach on floor in garage & laundry detergent in uncovered cup in resident bathroom at 9:30am in unlocked cabinet under sink (see pic & LIC809-D) both removed by staff. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Continue on LIC809-C File Review began at 10:30 AM: A review of six resident & five staff records as well as two resident’s medications was conducted. LPA reviewed resident’s files and learned that 4 out of 6 residents (R1,R2, R3, & R4) do not have an updated re-appraisals/needs & care plans and only 5 out of 6 residents have current physician’s reports. R1 has a diagnosis of dementia and does not have an updated physician’s assessment (LIC 602A) (see LIC 809-D’s). LPA reviewed a sample of staff records and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff annual training requirements for 2023 are on file. LPA was presented with proof of CPR & 1st Aid certification for staff that files were reviewed. Medication Audit began at 1:45 AM: Medications were centrally stored in locked cabinet in the facility office room area, however; during tour of the facility LPA observed unlocked kitchen drawer containing pre poured medications (see LIC 9102 for technical of pre poured medications). including unlocked mini refrigerator containing resident’s medications (see pic & LIC 809-D). Facility has a 30-day supply of medication for residents. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be complete and accurate. LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. Administrator Certificate for Administrator, Georgiano Santos 6019796740 expires 8/25/2024. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; and review facility emergency plan to ensure accuracy according to the needs of facility residents. Last Disaster Drill was conducted on 12/2/2022 (see LIC 809-D). Disaster drills are to be conducted quarterly and in different shifts. Appeal of Rights Given. Continue on LIC809-C The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting facility to submit the following documents to CCL by 1/25/2024: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Resident’s Copy of Current Administrators Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Jan 3, 2024

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.